The present invention relates to a vaccine containing the B subunits of heat-labile enterotoxin (LTB) of Escherdchia coli (E. coli) as a mucosal immunoadjuvant. The invention relates in particular to a vaccine of this type to prevent influenza infections in humans. However, the invention is not restricted to application in influenza vaccines.
It is the object of vaccination against infectious diseases to prevent or at least restrain infection of the vaccinated subject by stimulating an immune response against the Infectious agent through introduction of an antigen formulation derived from the particular pathogen. Ideally, the induced immune response should consist of two components, a humoral response (the production of antigen-specific antibodies) and a cellular response (the generation of specific cytotoxic T lymphocytes, capable of eliminating cells infected by the pathogen).
Many vaccination procedures involve the administration of a formulation containing inactivated or attenuated whole pathogen. However, for certain pathogens there is a considerable disadvantage to vaccination with whole pathogen, since such preparations, even though they are usually highly immunogenic, may have undesirable side effects. This explains the current trend towards the use of well-defined subunit vaccines or synthetic vaccines, substantially lacking the adverse side effects of the whole infectious agent. However, compared to whole pathogen, subunit vaccines or synthetic vaccines are often not very immunogenic, at least in the absence of an added adjuvant.
Adjuvants are substances or materials administered in conjunction with the antigen so as to stimulate the immune response against that antigen. There is a need for appropriate adjuvants which would boost the immune response against subunit antigens or synthetic antigens without causing undesirable side effects.
Influenza vaccine formulations have contained for a long time, and in some cases still contain, inactivated or attenuated whole virus. Such formulation may have considerable side effects, most notably fever and reactions at the site of injection. Nowadays, vaccination is usually done with a subunit formulation. This subunit vaccine, which causes less side reactions, only contains the two major surface antigens of the virus, the hemagglutinin (HA) and the neuraminidase (NA), in a more or less purified form. In most current vaccine formulations there is no added adjuvant present.
The inactivated or attenuated whole influenza virus vaccine as well as the subunit vaccine are usually administered via a single intramuscular (i.m.) injection. The protection against influenza infection, achieved by either vaccination procedure, is comparatively low, particularly in elderly people. The relatively low efficacy of vaccination against influenza is due in part to the high antigenic variability of the virus. However, there is reason to believe that the protection against influenza infection by vaccination can be improved by stimulation and/or modification of the immune response against the antigen.
In the case of influenza, or in general in cases in which the infection is contracted via the respiratory tract, strategies for improved vaccination efficacy should aim at the generation of not only an adequate T-cell-dependent IgG response in the circulation, but also at a local immune response (secretory IgA) in the lungs and nasal cavity as a first line of defence against invading infectious virus. Furthermore, a cellular immune response (cytotoxic T-cells) might also be important, particularly in restricting the infection. It has been demonstrated that administration of influenza vaccine via i.m. injection (the current route of administration) does not result in a local IgA response in the respiratory tract.
The present invention relates to the surprising finding that the presence of LTB in an intranasal vaccine formulation not only stimulates the IgG response in the circulation, relative to i.m. immunisation with the adjuvant-free immunogen vaccine, but also generates a local IgA response in the respiratory tract.
The intact heat-labile enterotoxin (LT), and its close relative cholera toxin (CT), are composed of one A subunit and a pentameric ring structure consisting of five identical B subunits. The A subunit has enzymatic, ADP-ribosylation, activity and attributes the toxic activity to the toxins. In the intestinal epithelium the A subunit induces persistent synthesis of second messenger cAMP, resulting in excessive electrolyte and concomitant fluid secretion to the lumen of the gut.
LT and CT are powerful mucosal immunogens. Upon local mucosal administration these molecules give rise to not only induction of a systemic antibody response directed against the toxin, but also to production of locally secreted antibodies, notably secretory IgA (S-IgA). LT and CT are also powerful mucosal immunoadjuvants. That is, when co-administered with an unrelated other immunogen, LT or CT may stimulate the systemic and mucosal antibody response against that immunogen. However, the toxicity of LT and CT has thusfar essentially precluded the use of LT or CT in human vaccine formulations.
In attempts to separate the toxic from the immune-stimulatory activities of LT or CT, detoxified mutants of the toxins, or the unmodified isolated pentameric B subunit (LTB or CTB, respectively), have been examined for their immunoadjuvant activity. Clearly, because the toxic ADP-ribosylation activity of the toxins resides in the A subunit, the presence of even trace amounts of unmodified A subunit or of LT or CT holotoxin in a human vaccine is highly undesirable.
The use of LTB as an adjuvant for influenza antigens has been investigated by Tamura and co-workers (Hirabashi et al.: Vaccine 8: 243-248 [1990]; Kikuta et al.,: Vaccine 8: 595-599 [1990]; Tamura et al. J.: Immunology 3: 981-988 [1992]; Tamura et al.: Vaccine 12: 419-426 [1994]; Tamura et al.: Vaccine 12: 1083-1089 [1994]). In these studies, based on the use of soluble influenza virus hemagglutinin (HA) vaccine, extracted and purified from influenza virus by treatment with Tween/ether according to Davenport et al (J. Lab. and Clin. Med. 63(1): 5-13 [1964], it was established that LTB, free of A subunit, lacks mucosal immunoadjuvant activity when administered intra-nasally in conjunction with the soluble HA antigen to mice. It was further demonstrated that the presence of trace amounts of holotoxin, for example residual holotoxin remaining in B subunit preparations isolated from holotoxin, restores the expression of adjuvant activity of LTB towards the soluble HA antigen. More in particular, when LTB from recombinant sources (and therefore, completely free of even the smallest trace amounts of A subunit) was used, a trace of holotoxin had to be added in order for the LTB to exert mucosal activity upon intranasal co-administration with the soluble HA antigen.
Surprisingly, it was found that isolated LTB from recombinant origin and therefore completely free of A subunit, does possess powerful immunoadjuvant activity depending on the nature or presentation form of the intranasally co-administered immunogen.
For example, adjuvant activity towards freely mixed small soluble antigens, such as ovalbumin or the soluble ectodomain of the envelope glycoprotein of human immunodeficiency virus (gp120), is low and often undetectable. On the other hand, it was found that LTB does exert very powerful adjuvant activity towards freely mixed large aggregated or particulate immunogens. These immunogens include influenza virus subunit antigen and keyhole limpet hemocyanin (KLH).
Accordingly, the present invention is concerned with a vaccine containing at least one particulate immunogen and an adjuvanting amount of LTB completely free of A subunit or toxic LT holotoxin.
As defined herein, xe2x80x9cparticulatexe2x80x9d means any association of viral, bacterial, or fungal antigens characteristic of the respective micro-organisms. More in particular, the term xe2x80x9cparticulate immunogenxe2x80x9d comprises aggregates, clusters, micelles, virosomes, rosettes, virus-like immunogen particles, and the like.
In the vaccine according to the present invention, in particular, LTB prepared from recombinant DNA technology can be utilised. The immunogen or immunogens may be derived from infective agents, such as viruses or bacteria.
Vaccines which apply to the above description were found not only to induce systemic immunoglobulin (e.g. IgG) against the immunogen upon mucosal (e.g. intra nasal) administration, but were also found to induce local secretion of IgA.
This latter property is particularly favourable for immunisation against diseases which are transmitted by mucosal infection with viruses (such as influenza virus, herpes virus, papilloma virus) or bacteria (like Chiamydia, pneumococs), or fungi.
A particular advantage of mucosal administration is the ease of vaccine application, which, furthermore, circumvents potential needlefobia with vaccinees receiving an intramuscular immunisation.
Although, for example in the case of influenza infection, high serum IgG titres are important for preventing systemic spread of the virus and protection of the lungs against infection, local S-IgA antibodies are crucial as a first line of defence for protection of the upper respiratory tract.
It has been reported that mucosal vaccination by i.n. administration of inactivated influenza virus in the absence of a mucosal adjuvant was not successful (Clancy: Drugs 50: 587-594 [1995]; Katz et al.; J. Infect. Dis. 175: 352-369 [1997]), probably because direct administration of an antigen to mucosal tissue will not result in an S-IgA response. Co-administration of a mucosal adjuvant seems to be a prerequisite to induce a local immune response against an immunogen. Remarkably, it was found that by i.n. immunisation according to the present invention the so-called common mucosal immune system is activated which results in secretion of S-IgA not only at the site of application (i.n.) but also in distant mucosal tissues (e.g. in the vaginal mucosal tissue).
Vaccines according to the present invention may contain immunogens of e.g. viral or bacterial origin, such as bacterial antigens, viral subunits (optionally inactivated) split viruses (optionally inactivated) inactivated viruses or bacteria, or attenuated (e.g. cold-adapted) live viruses, in a particulate form.
The LTB used according to the present invention is strictly free of toxic LTA or toxic holotoxin. Preferably, the LTB is prepared by recombinant DNA technology. Free of toxic LTA in the present context means strictly LTA-free.
In the vaccine according to the present invention the LTB can be used freely admixed with the particulate antigenxe2x80x94a covalent coupling between the antigen and the adjuvant can be established, however it is not needed to attain adequate adjuvant effect.
Apart from LTB and one or more immunogens the vaccine according to the present invention may contain an aqueous solvent, in particular a buffer, more in particular PBS (phosphate-buffered saline) as well as a stabiliser (e.g. PEG or methyl cellulose), and or glucose.
The components of the vaccine according to the present invention may be freeze dried or in a liquid form.
The vaccine according to the present invention may be present e.g. in bulk, or in an ampoule, or in a syringe, or in a nebuliser.
The vaccine according to the present invention may be administered by subcutaneous, or intramuscular, or intra-bronchial, or intra-nasal or intra-vaginal application or per os.